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Selective reduction in trabecular volumetric bone mineral density during treatment for childhood acute lymphoblastic leukemia

Selective reduction in trabecular volumetric bone mineral density during treatment for childhood acute lymphoblastic leukemia
Selective reduction in trabecular volumetric bone mineral density during treatment for childhood acute lymphoblastic leukemia
During treatment of childhood acute lymphoblastic leukemia (ALL) fracture incidence is increased. Studies using DXA, which measures a composite of both trabecular and cortical BMD, have shown reduced BMD during treatment. We investigated changes in compartmental (cortical and trabecular) volumetric BMD (vBMD) and bone geometry using peripheral quantitative computed tomography. These outcomes were also analysed in relation to adiposity and treatment factors. Thirty nine patients with ALL (64% male, median age 7.2years (4.1 - 16.9)) were compared to 34 healthy controls (50% male, median age 9.1years (4.4 - 18.7)). DXA-derived age-specific standard deviation scores (SDS) of the lumbar spine (LS) and femoral neck (FN) were reduced in subjects with ALL compared to controls (p?0.01). This persisted following adjustment for body size using height-specific SDS (LS -0.72±1.02 vs -0.18±0.72, p=0.01; FN -1.53±0.96 vs -0.74±0.74, p=0.001) and bone mineral apparent density (BMAD) SDS (LS -0.76±1.14 vs 0.04±1.08, p=0.01; FN -1.63±1.38 vs -0.16±1.20, p<0.001). Radial and tibial trabecular vBMD was also reduced (196.5±54.9mg/cm(3) vs 215.2±39.9mg/cm(3), p=0.03 and 232.8±60.3mg/cm(3) vs 267.5±60.2mg/cm(3), p=0.002, respectively), but cortical vBMD at the radius and tibia was similar in patients and controls. A lowered tibial bone strength index (BSI) was identified in patients with ALL (53.9±23.1mg/mm(4) vs 82.5±27.8mg/mm(4), p<0.001) suggesting lower fracture threshold from compressive forces. No relationships with measures of adiposity, duration of treatment or cumulative corticosteroid dose were identified. Our findings therefore suggest that reduction in trabecular vBMD during childhood ALL treatment may contribute to the observed increased fracture incidence and bony morbidity in this group.
acute lymphoblastic leukemia, bone mineral density, pQCT
8756-3282
765-770
Kohler, J. A.
9f6ad5e3-d74d-4dad-8847-7ffc7cb4f380
Moon, R. J.
954fb3ed-9934-4649-886d-f65944985a6b
Sands, R.
1033725c-2c81-4f55-ab79-d0d9975c2d1a
Doherty, L. J.
6123d9d3-82a9-4816-bf74-a7f3885ba73d
Taylor, P. A.
69e152b0-5e54-4ecf-9f40-b4c7099ea35d
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Dennison, E. M.
ee647287-edb4-4392-8361-e59fd505b1d1
Davies, J. H.
9f18fcad-f488-4c72-ac23-c154995443a9
Kohler, J. A.
9f6ad5e3-d74d-4dad-8847-7ffc7cb4f380
Moon, R. J.
954fb3ed-9934-4649-886d-f65944985a6b
Sands, R.
1033725c-2c81-4f55-ab79-d0d9975c2d1a
Doherty, L. J.
6123d9d3-82a9-4816-bf74-a7f3885ba73d
Taylor, P. A.
69e152b0-5e54-4ecf-9f40-b4c7099ea35d
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Dennison, E. M.
ee647287-edb4-4392-8361-e59fd505b1d1
Davies, J. H.
9f18fcad-f488-4c72-ac23-c154995443a9

Kohler, J. A., Moon, R. J., Sands, R., Doherty, L. J., Taylor, P. A., Cooper, C., Dennison, E. M. and Davies, J. H. (2012) Selective reduction in trabecular volumetric bone mineral density during treatment for childhood acute lymphoblastic leukemia. Bone, 51 (4), 765-770. (doi:10.1016/j.bone.2012.06.025). (PMID:22771958)

Record type: Article

Abstract

During treatment of childhood acute lymphoblastic leukemia (ALL) fracture incidence is increased. Studies using DXA, which measures a composite of both trabecular and cortical BMD, have shown reduced BMD during treatment. We investigated changes in compartmental (cortical and trabecular) volumetric BMD (vBMD) and bone geometry using peripheral quantitative computed tomography. These outcomes were also analysed in relation to adiposity and treatment factors. Thirty nine patients with ALL (64% male, median age 7.2years (4.1 - 16.9)) were compared to 34 healthy controls (50% male, median age 9.1years (4.4 - 18.7)). DXA-derived age-specific standard deviation scores (SDS) of the lumbar spine (LS) and femoral neck (FN) were reduced in subjects with ALL compared to controls (p?0.01). This persisted following adjustment for body size using height-specific SDS (LS -0.72±1.02 vs -0.18±0.72, p=0.01; FN -1.53±0.96 vs -0.74±0.74, p=0.001) and bone mineral apparent density (BMAD) SDS (LS -0.76±1.14 vs 0.04±1.08, p=0.01; FN -1.63±1.38 vs -0.16±1.20, p<0.001). Radial and tibial trabecular vBMD was also reduced (196.5±54.9mg/cm(3) vs 215.2±39.9mg/cm(3), p=0.03 and 232.8±60.3mg/cm(3) vs 267.5±60.2mg/cm(3), p=0.002, respectively), but cortical vBMD at the radius and tibia was similar in patients and controls. A lowered tibial bone strength index (BSI) was identified in patients with ALL (53.9±23.1mg/mm(4) vs 82.5±27.8mg/mm(4), p<0.001) suggesting lower fracture threshold from compressive forces. No relationships with measures of adiposity, duration of treatment or cumulative corticosteroid dose were identified. Our findings therefore suggest that reduction in trabecular vBMD during childhood ALL treatment may contribute to the observed increased fracture incidence and bony morbidity in this group.

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More information

e-pub ahead of print date: 4 July 2012
Published date: October 2012
Keywords: acute lymphoblastic leukemia, bone mineral density, pQCT
Organisations: Faculty of Medicine, Human Development & Health

Identifiers

Local EPrints ID: 341033
URI: http://eprints.soton.ac.uk/id/eprint/341033
ISSN: 8756-3282
PURE UUID: 84739a28-39ca-4c14-8fcc-1acd57509a64
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for E. M. Dennison: ORCID iD orcid.org/0000-0002-3048-4961

Catalogue record

Date deposited: 11 Jul 2012 11:43
Last modified: 18 Feb 2021 16:48

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